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Measurements in the infrared wavelength domain allow direct assessment of the physical state and energy balance of cool matter in space, enabling the detailed study of the processes that govern the formation and evolution of stars and planetary systems in galaxies over cosmic time. Previous infrared missions revealed a great deal about the obscured Universe, but were hampered by limited sensitivity.

SPICA takes the next step in infrared observational capability by combining a large 2.5-meter diameter telescope, cooled to below 8 K, with instruments employing ultra-sensitive detectors. A combination of passive cooling and mechanical coolers will be used to cool both the telescope and the instruments. With mechanical coolers the mission lifetime is not limited by the supply of cryogen. With the combination of low telescope background and instruments with state-of-the-art detectors SPICA provides a huge advance on the capabilities of previous missions.

SPICA instruments offer spectral resolving power ranging from R ~50 through 11 000 in the 17–230 μm domain and R ~28.000 spectroscopy between 12 and 18 μm. SPICA will provide efficient 30–37 μm broad band mapping, and small field spectroscopic and polarimetric imaging at 100, 200 and 350 μm. SPICA will provide infrared spectroscopy with an unprecedented sensitivity of ~5 × 10−20 W m−2 (5σ/1 h)—over two orders of magnitude improvement over what earlier missions. This exceptional performance leap, will open entirely new domains in infrared astronomy; galaxy evolution and metal production over cosmic time, dust formation and evolution from very early epochs onwards, the formation history of planetary systems.

The present study evaluated the behaviour of the AusBeef model for beef production as part of a 2 × 2 study simulating performance on forage-based and concentrate-based diets from Oceania and North America for four methane (CH4)-relevant outputs of interest. Three sensitivity analysis methods, one local and two global, were conducted. Different patterns of sensitivity were observed between forage-based and concentrate-based diets, but patterns were consistent within diet types. For the local analysis, 36, 196, 47 and 8 out of 305 model parameters had normalized sensitivities of 0, >0, >0·01 and >0·1 across all diets and outputs, respectively. No parameters had a normalized local sensitivity >1 across all diets and outputs. However, daily CH4 production had the greatest number of parameters with normalized local sensitivities >1 for each individual diet. Parameters that were highly sensitive for global and local analyses across the range of diets and outputs examined included terms involved in microbial growth, volatile fatty acid (VFA) yields, maximum absorption rates and their inhibition due to pH effects and particle exit rates. Global sensitivity analysis I showed the high sensitivity of forage-based diets to lipid entering the rumen, which may be a result of the use of a feedlot-optimized model to represent high-forage diets and warrants further investigation. Global sensitivity analysis II showed that when all parameter values were simultaneously varied within ±10% of initial value, >96% of output values were within ±20% of the baseline, which decreased to >50% when parameter value boundaries were expanded to ±25% of their original values, giving a range for robustness of model outputs with regards to potential different ‘true’ parameter values. There were output-specific differences in sensitivity, where outputs that had greater maximum local sensitivities displayed greater degrees of non-linear interaction in global sensitivity analysis I and less variance in output values for global sensitivity analysis II. For outputs with less interaction, such as the acetate : propionate ratio and microbial protein production, the single most sensitive term in global sensitivity analysis I contributed more to the overall total-order sensitivity than for outputs with more interaction, with an average of 49, 33, 15 and 14% of total-order sensitivity for microbial protein production, acetate : propionate ratio, CH4 production and energy from absorbed VFAs, respectively. Future studies should include data collection for highly sensitive parameters reported in the present study to improve overall model accuracy.

As demand for animal products, such as meat and milk, increases, and concern over environmental impact grows, mechanistic models can be useful tools to better represent and understand ruminant systems and evaluate mitigation options to reduce greenhouse gas emissions without compromising productivity. The objectives of the present study were to describe the representation of processes for growth and enteric methane (CH4) production in AusBeef, a whole-animal, dynamic, mechanistic model for beef production; evaluate AusBeef for its ability to predict daily methane production (DMP, g/day), gross energy intake (GEI, MJ/day) and methane yield (MJ CH4/MJ GEI) using an independent data set; and to compare AusBeef estimates to those from the empirical equations featured in the current National Academies of Sciences, Engineering and Medicine (NASEM, 2016) beef cattle requirements for growth and the Ruminant Nutrition System (RNS), a dynamic, mechanistic model of Tedeschi & Fox, 2016. AusBeef incorporates a unique fermentation stoichiometry that represents four microbial groups: protozoa, amylolytic bacteria, cellulolytic bacteria and lactate-utilizing bacteria. AusBeef also accounts for the effects of ruminal pH on microbial degradation of feed particles. Methane emissions are calculated from net ruminal hydrogen balance, which is defined as the difference between inputs from fermentation and outputs due to microbial use and biohydrogenation. AusBeef performed similarly to the NASEM empirical model in terms of prediction accuracy and error decomposition, and with less root mean square predicted error (RMSPE) than the RNS mechanistic model when expressed as a percentage of the observed mean (RMSPE, %), and the majority of error was non-systematic. For DMP, RMSPE for AusBeef, NASEM and RNS were 24·0, 19·8 and 50·0 g/day for the full data set (n = 35); 25·6, 18·2 and 56·2 g/day for forage diets (n = 19); and 21·8, 21·5 and 41·5 g/day for mixed diets (n = 16), respectively. Concordance correlation coefficients (CCC) were highest for GEI, with all models having CCC > 0·66, and higher CCC for forage diets than mixed, while CCC were lowest for MY, particularly forage diets. Systematic error increased for all models on forage diets, largely due to an increase in error due to mean bias, and while all models performed well for mixed diets, further refinements are required to improve the prediction of CH4 on forage diets.

Introduction – The potential impact of electronic health records (EHR) in driving tobacco treatment behaviours within healthcare settings has been established. However, little is known about the administrative variables that may undermine effectiveness in real world settings.

Aims – Assist healthcare planners interested in implementing tobacco-EHR systems by identifying an EHR framework that is consistent with published treatment guidelines, and the important organisational variables that can undermine the effectiveness of tobacco-EHR.

Methods – This paper considers the established literature on EHR implementation and physician behaviour change, and integrates this understanding with the observations of an expert workgroup tasked with facilitating tobacco-EHR implementation in Southeastern Pennsylvania.

Results/ Findings – System change in this topic area will continue to be problematic unless attention is paid to several important lessons regarding: 1) the evolving healthcare regulatory environment, 2) the integration of tobacco use treatment into primary care, and 3) the existing social and organisational barriers to uptake of evidence-based recommendations.

Conclusion – Healthcare organisations seeking to reduce the impact of tobacco use on their patients are well served by tobacco-EHR systems that improve care. Managers can avoid sub-optimal implementation by considering several threats to effectiveness before proceeding to systems change.

Evidence about the cost-effectiveness and cost utility of computerised
cognitive–behavioural therapy (CCBT) is still limited. Recently, we
compared the clinical effectiveness of unsupported, online CCBT with
treatment as usual (TAU) and a combination of CCBT and TAU (CCBT plus
TAU) for depression. The study is registered at the Netherlands Trial
Register, part of the Dutch Cochrane Centre (ISRCTN47481236).

Aims

To assess the cost-effectiveness of CCBT compared with TAU and CCBT plus
TAU.

Method

Costs, depression severity and quality of life were measured for 12
months. Cost-effectiveness and cost-utility analyses were performed from
a societal perspective. Uncertainty was dealt with by bootstrap
replications and sensitivity analyses.

Results

Costs were lowest for the CCBT group. There are no significant group
differences in effectiveness or quality of life. Cost-utility and
cost-effectiveness analyses tend to be in favour of CCBT.

Conclusions

On balance, CCBT constitutes the most efficient treatment strategy,
although all treatments showed low adherence rates and modest
improvements in depression and quality of life.

Computerised cognitive–behavioural therapy (CCBT) might offer a solution
to the current undertreatment of depression.

Aims

To determine the clinical effectiveness of online, unsupported CCBT for
depression in primary care.

Method

Three hundred and three people with depression were randomly allocated to
one of three groups: Colour Your Life; treatment as usual (TAU) by a
general practitioner; or Colour Your Life and TAU combined. Colour Your
Life is an online, multimedia, interactive CCBT programme. No assistance
was offered. We had a 6-month follow-up period.

Results

No significant differences in outcome between the three interventions
were found in the intention-to-treat and per protocol analyses.

Conclusions

Online, unsupported CCBT did not outperform usual care, and the
combination of both did not have additional effects. Decrease in
depressive symptoms in people with moderate to severe depression was
moderate in all three interventions. Online CCBT without support is not
beneficial for all individuals with depression.

Perspectives from 22 countries on aspects of the legal environment for selection are presented in this article. Issues addressed include (a) whether there are racial/ethnic/religious subgroups viewed as “disadvantaged,” (b) whether research documents mean differences between groups on individual difference measures relevant to job performance, (c) whether there are laws prohibiting discrimination against specific groups, (d) the evidence required to make and refute a claim of discrimination, (e) the consequences of violation of the laws, (f) whether particular selection methods are limited or banned, (g) whether preferential treatment of members of disadvantaged groups is permitted, and (h) whether the practice of industrial and organizational psychology has been affected by the legal environment.

Objectives: Multidisciplinary and multifactorial interventions seem to be effective in preventing falls. We aimed to assess the cost-effectiveness of a multidisciplinary fall prevention program compared with usual Dutch healthcare in community-dwelling people 65 years of age or older who experienced a fall.

Methods: Cost-effectiveness and cost-utility analysis were performed from a societal perspective. Falls and healthcare utilization were continuously measured for 12 months. Daily functioning and quality of life were measured at baseline, after 4 and 12 months. Bootstrap analyses were performed to estimate uncertainty of the findings and sensitivity analysis to assess the generalizability of assumptions made.

Results: One hundred sixty-six participants were randomly allocated to the experimental group and 167 to the control group. The overall response rate was 74 percent. Healthcare and patient and family costs of both groups were comparable. Our analyses showed no effect of the intervention program on falls, daily functioning, or quality of life measures.

Conclusions: The multidisciplinary intervention program to prevent falls was not cost-effective compared with usual care in the Netherlands. Notwithstanding our findings, however, falls still have an important impact on society and individuals in terms of costs and effects. Economic evaluations studying promising interventions to prevent falls, therefore, remain necessary.

Objectives: In the next decades, the number of stroke patients is expected to increase. Furthermore, organizational changes, such as stroke services, are expected to be implemented on a large scale. The purpose of this study is to estimate the future healthcare costs by taking into account the expected increase of stroke patients and a nationwide implementation of stroke services.

Methods: By means of a dynamic multistate life table, the total number of stroke patients can be projected. The model calculates the annual number of patients by age and gender. The total healthcare costs are calculated by multiplying the average healthcare costs specified by age, gender, and healthcare sector with the total number of stroke patients specified by age and gender.

Results: In the year 2000, the healthcare costs for stroke amounted to €1.62 billion. This amount is approximately 4.4 percent of the total national healthcare budget. Projections of the total costs of stroke based on current practice result in an increase of 28 percent (€2.08 billion) in the year 2020. A nationwide implementation of stroke services in 2020 would result in a substantial reduction of the costs of stroke (€1.81 billion: 13 percent cost reduction) compared with the regular care scenario.

Conclusions: A nationwide implementation of stroke services is a strong policy tool for cost containment of health care in an aging population like that in the Netherlands. Policy makers should optimize the organization of stroke care.

Objectives: Even when policy makers show interest and evidence-informed and convincing HTA studies are available, use of assessment products is not guaranteed. In this article, we report our experience with knowledge brokering to foster evidence-informed policy making on cost-effective treatment and reimbursement of assisted reproduction in The Netherlands.

Methods: From earlier work in the field of knowledge brokering, we foresaw the need for a deliberative strategy to manage the inherent tension between scientific rigor demanded by researchers and responsiveness to real-time needs demanded by policy makers. Therefore, we structured the process in three distinct steps: (i) agreement about the main messages from the research, (ii) analysis of the policy context and of the meaning of the main messages for the actors involved, and (iii) an invitational meeting to make recommendations for action.

Results: One of the recommendations that would require changes in ministerial policy was followed up instantly, whereas the other recommendation is still under debate. The Dutch Society of Obstetrics and Gynecology activated the revision of two guidelines. The patient organization uses the new scientific insights in informing members and the public. Closing the loop, The Netherlands Organisation for Health Research and Development (ZonMw) funded research to close knowledge gaps that became apparent in the process.

Conclusions: Knowledge brokering is a promising approach to bring HTA into practice. We conclude that the methodologies to feed research results into the policy process are still in an incipient stage and need further development.

Objectives: Although psychiatric comorbidity is relevant for a number of diseases, it is often ignored in technology assessment. This study examines the service use rate in mental healthcare facilities and related costs for stroke patients discharged from the University Hospital Maastricht between 1987 and 1995.

Methods: Through anonymous record linkage, the medical registration of the hospital and the registration of the Maastricht Mental Health Case Register were linked.

Results: Linkage succeeded for 16% of the 2,020 stroke patients, indicating that these patients used mental health services during a 10-year period around the stroke (±5 years). Of the users' group, 88% had a mental healthcare contact following stroke. Regression analysis shows that age, length of hospital stay, and mental healthcare contact before stroke are associated with mental healthcare use after stroke. It is remarkable in that there is already an increase in the consumption of mental health care in the prodromal phase just before the stroke occurred. When comparing costs before and after stroke, the outpatient costs increased on average by \epsfbox{cj108-4-euro.eps}42.64, semi-institutionalized costs increased on average by \epsfbox{cj108-4-euro.eps}208.10, and intramural costs by \epsfbox{cj108-4-euro.eps}1,189.21. The total increase in costs is \epsfbox{cj108-4-euro.eps}1,439.95. For all mental healthcare facilities, the increase in costs is significant.

Conclusions: No study so far has revealed the total costs of mental healthcare facilities following stroke. Extrapolating these costs to the Netherlands illustrates that stroke patients have a high psychiatric comorbidity, inducing about 1.3% of total mental healthcare costs.

Huntington's disease (HD) is an autosomal dominant disorder of the central nervous system, characterised by neurological, cognitive and psychiatric pathology. Recently the causative genetic defect was discovered. We present a retrospective study of 59 HD patients, investigating correlations between molecular and clinical data.

The correlation between CAG-repeatlength and age at onset is confirmed. No correlations between this biological marker and other clinical features are found (symptoms at onset, mode of progression of the disease).

The consequences of these findings for predictive testing are discussed. Furthermore, a short overview of the predictive testing procedure in the Center for Human Genetics in Leuven (Belgium) is given.

1. Transport of L-homocitrulline, an amino acid which occurs in milk products, was studied with rat small intestine in vitro and from the human mouth in vivo. Absorption was partially dependent, in both systems, on the presence of sodium ions.

2. Metabolic inhibitors decreased L-homocitrulline uptake across the small intestine. Transport across the intestine did not occur against the concentration gradient but did show saturation kinetics.

3. The barbiturate, amytal, did not inhibit buccal absorption. Saturation kinetics were demonstrated.

4. Experiments were conducted with L-citrulline, or other amino acids, as possible inhibitors of L-homocitrulline transport. Results were compatible with Na+-dependent carrier-mediated uptake across the buccal mucosa. Active transport could be involved with the small intestine assuming that L-homocitrulline has a low affinity for the carrier system.

In a group of 32 adult volunteers given subunit influenza virus vaccine containing 250 international units (i.u.) of A/Victoria/3/75, 250 i.u. of A/Scotland/ 840/74 and 300 i.u. of B/Hong Kong/8/73, there were substantial increases in the geometric mean homologous haemagglutination-inhibiting (HI) antibody titres. There was also substantial boosting of the antibodies to the earlier variants of the Hong Kong (H3N2) series and to a later variant of the Asian (H2N2) series. There was no boosting of antibodies to the A/FM/1/47 strain, a representative member of the H1N1 series, but two individuals showed substantial rises to A/PR/8/34 (H0N1).

There were increases in the HI titre of antibodies cross reactive with two recent isolations, A/Texas/1/77, and A/Victoria/35/77, but the majority of vaccinees failed to reach antibody titres likely to be protective against such strains.

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